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Dáil Éireann debate -
Wednesday, 15 Nov 1989

Vol. 393 No. 2

Ceisteanna—Questions. Oral Questions. - Community Care Services.


asked the Minister for Health the proposals he has for the development and improvement of community care services; and if he will make a statement on the matter.

Despite the financial restrictions of recent years it has been my general policy, as far as possible, to protect community care services. I am continuing with the policy of changing the emphasis away from institutional care to health promotion and primary care.

The new general medical services contract, which provides for the payment of general practitioners on a capitation basis, came into operation on 1 March 1989. This new arrangement constitutes a sound base, not only for the future of the GMS on a cost effective basis, but also for the development of general practice as a whole, enabling it to fulfil its full potential as the primary core of an integrated and comprehensive health service.

As far as psychiatric services are concerned, progress continues to be made in developing a community-based psychiatric service as outlined in the report Planning for the Future. There has been a considerable expansion of community-based facilities such as day hospitals, day centres, hostels and community residences. For example, at the end of 1988 there were 32 day hospitals and 47 day centres catering for some 7,500 persons as well as 272 hostels and community residences providing accommodation for 1,800 persons who suffer from psychiatric illness.

In October 1988 the report of the working party on services for the elderly was published. The report, which has wide ranging recommendations in relation to services for the elderly, has been accepted in principle by the Government.

The Department, in conjunction with the other Departments involved and the health boards, are looking at ways of implementing the recommendations of the report in so far as resources will permit.

The level of services for the handicapped is gradually being improved through the joint efforts of the health boards and voluntary agencies.

The recently published report of the Commission on Health Funding contains wide-ranging recommendations, many of which relate to the area of community care. I am examining these proposals at present and I am consulting with all health care organisations and bodies concerned on the issues raised.

That has a sham ring to it.

In regard to further improvements in the community care services I would intend, as additional resources become available, that they be largely concentrated in this area.

The Minister said that he is very committed to the development of the community care services. Would the Minister agree that there is an urgent requirement to increase the number of public health nurses in view of the practice in general hospitals of discharging people early? In my area, the Southern Health Board area, the number of public health nurses is way below the national average and is not adequate to deal with the numbers being discharged from hospital.

Secondly, would the Minister agree that home helps are being paid a pittance and as a consequence are losing interest in the work? It has come to my notice that patients who are required to return to out-patients for treatment very often do not have transport, or the money to meet the cost of transport to the hospital and are therefore not returning for treatment.

That is a very long question, Deputy.

Thank you very much, a Cheann Comhairle, for allowing it.

The level of services in the community is being improved, as I pointed out in my reply to the Deputy. For example the hostel provision for the mentally handicapped has been increased from accommodating 773 in 127 hostels to 1,056 residents in 178 hostels in 1988 — an increase of 51 hostels in that period. Similarily, there was an increase in the number of day centres and workshops and the additional 71 new centres cater for 2,350 mentally handicapped adults.

I note the Deputy's point about patients travelling to and from out-patients. I have been in contact with the agencies asking them to look at the organisation of services to ensure that there is the minimum inconvience for patients. Certainly patients in rural Ireland, and in some areas of the city, have always had a problem finding their way to out-patients. I am sure the Deputy would accept that it would never be possible for a health board to provide a transport service for everybody who would want to go to hospital, because it would be using a resource that then would not be available for other priority needs.

Would the Minister not agree that a vital aspect of the community care service is the work of public health nurses? Is the Minister aware that virtually every health board have sent out a circular to public health nurses which greatly restricts their travelling and mileage allowances at this time and makes their work virtually inoperable?

I am aware that in 1987 public health nurses, in common with all others working in the public service, had their travelling allowances reduced. However, in 1988 the level was restored——

Not in the Minister's own health board area.

——and that still obtains.

That disposes of questions for today.